Workup/Staging

Question 1

What are some common presenting Sx in pts with NPC?

Answer 1

Neck mass (>60%); epistaxis, headache, diplopia, facial numbness, otalgia, and nasal congestion. Trismus and/or CN deficits are seen with more advanced Dz.

Question 2

What is the workup for a pt who presents with a neck node and a suspicious mass in the NPX according to the NCCN guidelines?

Answer 2

H&P, nasopharyngolaryngoscopy and Bx of the lesion, MRI with gadolinium of base of skull, NPX, and neck to clavicles, CT of skull base/neck with contrast as indicated; dental, speech and swallow, and audiology evaluations as indicated, and PET scan or other imaging to evaluate for DM

Question 3

What is the DDx for a pt with a nasopharyngeal mass?

Answer 3

Carcinoma, lymphoma, melanoma, plasmacytoma, angiofibroma, RMS (children), and mets

Question 4

What % of NPC pts present with palpable LAD?

Answer 4

60%–90%

Question 5

What % of NPC pts present with bilat LAD?

Answer 5

Up to 50%

Question 6

Adenopathy near the mastoid tip is indicative of involvement of which nodal group?

Answer 6

Retropharyngeal nodes (node of Rouviere)

Question 7

Pts with upper-level V LAD are most likely to have what kind of H&N primary?

Answer 7

NPC

Question 8

What factors predict for DM in pts with NPC?

Answer 8

Lower neck nodal involvement, advanced nodal stage, and nonkeratinizing undifferentiated (WHO type III) histology

Question 9

What are the common DM sites for NPC?

Answer 9

Bones, lungs, and liver

Question 10

What correlates better with DM spread in NPC: N stage or T stage?

Answer 10

N stage